Transcript Economic, health and human rights issues of racial and ethnic

Overview of Economic,
Health, and Human Rights
Issues of Racial and Ethnic
Minorities
Martin Donohoe
Outline
• Exploitation
• Economics, Education, Environment,
Health Care, Criminal Justice System
• International Perspective
• Solutions
Colonial Exploitation
• Christopher Columbus’ log entry upon
meeting the Arawaks of the Bahamas:
“They…brought us…many…things…They
willingly traded everything they
owned…They do not bear arms…They
would make fine servants…With fifty men
we could subjugate them all and make
them do whatever we want.”
Colonial Exploitation
• Sir Jeffrey Amherst (French and
Indian Wars - smallpox):
–“You would do well to try to
inoculate the Indians, by means of
blankets, … to extirpate this
execrable race”
Colonial Exploitation
• Winston Churchill (speaking in favor of
RAF’s “experimental” bombing of Iraqis in
1920s, which killed 9,000 people with 97
tons of bombs):
“I am strongly in favor of using poisoned
gas against uncivilized tribes to spread a
lively terror…against recalcitrant Arabs as
an experiment”
Colonial Exploitation
• Cecil Rhodes (Rhodesia, Rhodes
Scholarship, DeBeers Mining Company):
“We must find new lands from which we
can easily obtain raw materials and at the
same time exploit the cheap slave labour
that is available from the natives of the
colonies. The colonies would also provide
a dumping ground for the surplus goods
produced in our factories.”
Historical and Contemporary
Exploitation
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Slavery
Built U.S. infrastructure
Apartheid
Civil Rights Movements (U.S. and
international)
• Native American and immigration
policies
Exploitation leads to:
• Maldistribution of wealth and resources
• Environmental degradation
• Wars
Racial Disparities: Economic
• Full-time African-American and Latinos
earn 75% of what whites earn
• Median income of black U.S. families as a
percent of white U.S. families:
– 60% in in 1968
– 62% in 2002
– 62% in 2011 (69% for Hispanic families)
Racial Disparities: Economic
• Recession, housing crisis has hit black
and Latino families harder than white
families
– Home ownerships rates: whites (73%),
Latinos (48%), African-Americans (43%)
– 7.5% on Blacks live in substandard housing
(vs. 2.8 % of Whites)
• Minorities face higher levels of
unemployment
Poverty and Hunger
• U.S.: 14.3% of residents and 20% of
children live in poverty
– Rates of poverty in Blacks = almost 3X Whites
(Hispanics 2.5X Whites)
• Poverty associated with worse physical
and mental health
Income Inequality
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Lower life expectancy
Higher rates of infant and child mortality
Short height
Poor self-reported health
AIDS
Depression
Mental Illness
Obesity
Voltaire
“The comfort of the rich
rests upon an abundance
of the poor”
Hudson River, 2009
Functional Apartheid
• Segregated communities
• Stress consequent to ongoing racism and
poverty
• Undocumented immigrants face constant
threat of deportation, disruption of family
and social relationships
Functional Apartheid:
Voter Restriction Measures
• Photo ID requirements
• Limits on number of polling sites and poll
hours
• Elimination of Sunday voting
• Long waits
• Limits on early voting
• Gerrymandering districts
• Intimidation
Functional Apartheid:
Voter Restriction Measures
• Stated aim: eliminate voter fraud
– 2000-2010: 643 million ballots cast in general
elections, 441 killed by lightning, 13 credible
cases of in-person voter impersonation
– Recent study of 146 million registered voters
found 10 cases of voter impersonation
• Result: potential disenfranchisement of
tens of millions of voters, mostly poor,
elderly, and racial minorities
Undocumented Immigrants
• 25 million non-citizens in U.S.
– 11-12 million undocumented
• 80% of these in labor force
– 2/3 lack insurance, source of non-emergency
care (and many afraid to visit emergency
rooms)
– Children particularly affected
Functional Apartheid
• Undocumented immigrants pay taxes:
– State and local income
– Property
– Excise taxes
– Employer’s share of Social Security
– Medicare
– Unemployment taxes
Functional Apartheid
• BUT, they are not eligible for many public services:
– Medicaid
– Supplemental Nutritional Assistance Program
– Social Security
– Medicare
• All immigrants heavily subsidize Medicare’s Trust
Fund (reducing immigration could seriously
undermine Medicare)
– Unemployment benefits
– Temporary cash assistance
Educational Apartheid
• High levels of de facto school segregation
by race and SES
• Gross discrepancies in per-pupil spending
and teacher salaries
• Achievement and graduation gaps growing
Benefits of Education
• For every $1 spent on early childhood
education, up to $17 are saved from
increased school achievement,
improved health, reduced crime, and
reduced reliance on public assistance
• Income increases 11% for every year
of education
Benefits of Education
• College graduates live 5 years longer
than high school dropouts
• Eliminating educational inequities
would have saved 8X as many lives
as medical advances from 1996-2002
Environmental Racism
• Polluting factories/waste
dumps/incinerators more common in lower
SES neighborhoods
• “Cancer Belt” (Baton Rouge to New
Orleans)
• Poor, African-Americans, and Hispanics
more commonly exposed to lead, other
toxins
Pesticides
• EPA: U.S. farm workers suffer up to 300,000
pesticide-related acute illnesses and injuries per
year
– 25 million cases/yr worldwide
• NAS: Pesticides in food could cause up to 1
million cancers in the current generation of
Americans
• WHO: 1,000,000 people killed by pesticides over
the last 6 years
Racial Disparities in Health Care
Coverage
• Percent uninsured:
– Hispanics = 24%
– African-Americans = 16%
– Asians = 15%
– Whites = 10%
– Undocumented immigrants = 100%
(emergency care exception)
• CA Proposition 189
Racial Disparities: Health Care
• Higher maternal and infant mortality
• Higher death rates for most diseases
• Shorter life expectancies for African-Americans
– Not for Hispanic Americans (healthy
immigrant effect and Hispanic paradox may
be relevant, but largely due to decreased
tobacco use)
Racial Disparities: Health Care
• Fewer diagnostic tests / therapeutic
procedures / pain medications
• US spending on cystic fibrosis R &
D/patient advocacy = 3X spending on
sickle cell disease
– CF afflicts 1/3 as many US citizens as
SCD
Health Disparities Among
Latinos
• Higher rates of:
– Overweight and obesity
– Certain cancers
– Stroke
– Diabetes
– Asthma/COPD
– Chronic liver disease/cirrhosis
– HIV/AIDS
– Homicide
Racial Disparities in Health Care:
African-Americans
• Equalizing the mortality rates of
whites and African-Americans
would have averted 686,202
deaths between 1991 and 2000
–Whereas medical advances
averted 176,633 deaths
• AJPH 2004;94:2078-2081
Diseases Responsible for
Illness and Death
• Deaths in 2000 attributable to:
–AMI – 193,000
–CVD – 168,000
–Lung CA – 156,000
– AJPH 2011;101:1456-1465
Social Factors Responsible for
Illness and Death
• Deaths in 2000 attributable to:
– Low education: 245,000
– Racial segregation: 176,000
– Low social support: 162,000
– Individual-level poverty: 133,000
– Income inequality: 119,000 (population-attributable
mortality – 5.1%)
– Area-level poverty: 39,000 (population-attributable
mortality – 1.7%)
– AJPH 2011;101:1456-1465
Deaths per year
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Tobacco = 400,000 (+ 50,000 ETS)
Obesity = 300,000
Alcohol = 100,000
Microbial agents = 90,000
Toxic agents = 60,000 (likely higher)
Firearms = 35,000
Sexual behaviors = 30,000
Motor vehicles = 25,000
Illicit drug use = 20,000
Exploitation: Post-WW II Human
Subject Experimentation
• Tuskegee Syphilis Study
• Guatemalan Syphilis Experiment
Exploitation: Contemporary Research
Imbalances
• Unethical research on special populations
(cultural minorities, prisoners, developing
world, etc.)
• 90% of research dollars spent on diseases
affecting 10% of the world’s population
• Limited access of developing world to
results due to scarcity of open-access
publications
Medical Care
• 50% of global health care budget
spent in the U.S.
• Per capita expenditure on health
care:
–U.S. = $8,160
–Typical poor African/Asian country
= $5-10
Exploitation: The Medical Brain
Drain
• Five times as many migrating doctors
flow from developing to developed
nations than in the opposite direction
• “Inverse care law”:
–Those countries that need the most
health care resources are getting
the least
Racism in the Criminal Justice
System
• Violent crime associated with poverty, not race
• Persons of color are more likely than whites to be:
– Stopped by the police (e.g., “Driving while black”,
“Stop and frisk”)
– Abused by the police
– Arrested
– Denied bail
– Charged with a serious crime
– Convicted
– Receive a harsher sentence
Race and Detention Rates
• African-Americans: 1,815/100,000
– More black men behind bars than in
college
– 13% of black men currently have no
voting privileges
• Latino-Americans: 609/100,000
• Caucasian-Americans: 235/100,000
• Asian-Americans: 99/100,000
Immigration and Incarceration
• 13.1% of US population foreign-born
• 5% of US prison population not US
citizens
• Immigrants less likely to be criminals than
native-born US citizens (even after
accounting for fact that many immigrant
“criminals” incarcerated for immigration
offenses)
Immigration Detention Centers
• Run by Immigration and Customs Enforcement, a branch
of DHS
– Haphazard network of governmentally- and privatelyrun jails
• Increasing numbers of detainees (“War on Immigration”)
– Fastest-growing form of detention in U.S. (209,000 in
2009; 429,000 in 2011)
• Almost ½ incarcerated for immigration or traffic offenses
– Cost of quota (ICE funding requires 34,000 beds be
kept occupied daily) = $2 billion = DEA budget
– Lucrative business
Outside the U.S.
• Racial and cultural inequalities
• Poverty, famine, war
• Governments/corporations promoting
poverty and worsening maldistribution of
wealth and resources through trade
agreements, internalization of profits and
externalization of costs
The Third World Debt Crisis
• Each African child inherits approximately
$379 in debt at birth
• Countries spend more each year repaying
debt than on education and healthcare
Consequences of Debt Repayment
Agreements
• Government spending on food, fuel and
farming subsidies reduced
• Social service (healthcare/education)
program spending cut
• Countries strip and sell their natural
resources
Foreign Aid
• In total dollars: U.S. #1
• As a % of GDP, U.S. #21
• U.S. Aid: Over 1/3 military, 1/4
economic, 1/3 for food and
development
Foreign Aid
• Americans think that 24% of the
federal budget goes toward
foreign aid
• 0.19% of the total federal budget,
vs. UN target of 0.7%
U.S. Charitable Giving
• Approximately $250
billion/year
– 2.5% of income
–2.9% at height of Great
Depression
U.S. International NonCooperation/Isolationism
• Failure to sign or approve:
–Kyoto Protocol on Climate
Change
–International Covenant on
Economic, Social, and Cultural
Rights
U.S. International NonCooperation/Isolationism
• Failure to sign or approve:
–Convention on the Rights of the
Child
–Convention on the Elimination of
Discrimination Against Women
–UN Convention on the Rights of
Disabled Persons
U.S. International NonCooperation/Isolationism
• Failure to sign or approve
–UN Declaration of the Rights of
Indigenous Peoples
–The Stockholm Convention on
Persistent Organic Pollutants
–WHO International Code of
Marketing of Breast Milk Substitutes
U.S. International NonCooperation/Isolationism
• Failure to follow World Court
Decisions
• Failure to recognize International
Criminal Court
Primo Levi
“A country is considered the
more civilized the more the
wisdom and efficiency of its
laws hinder a weak man from
becoming too weak or a
powerful one too powerful.”
Solutions
• More equitable distribution of
medical research funds and health
care dollars
• Living wage laws
– E.g., NY, LA, Chicago, and
Philadelphia
• Education reforms
Solutions
• Creation of healthier communities
• Stronger environmental and
occupational and safety laws /
enhanced enforcement
• Single payer health care
– Canadian blacks are as healthy as Canadian
whites
Solutions
• Improve status of women / access to
reproductive health care
• Increase racial and ethnic diversity of physician
workforce
• Overhaul immigration policy
– Pass Dream Act
• Reparations
• Changes in law enforcement and sentencing
Fyodor Dostoyevsky
“A society should be judged not
by how it treats its outstanding
citizens but by how it treats its
criminals”
Solutions
• Publicly financed campaigns and
campaign finance reform
• Proportional representation
• Instant runoff voting/cumulative
voting/range (rating) voting
Solutions
• Increase U.S. voter turnout
– U.S. 139/172 worldwide
– Wealthy vote at almost twice rate of poor
– Whites > Blacks > Hispanics
– Old > Young
– Property owners > Renters
• Activism / Protesting / Whistleblowing
• Halt disenfranchisement, overturn voter restriction laws
• Work in Groups
Günter Grass
“The first job of a citizen is to
keep your mouth open.”
Anita Roddick
"If you think you are too
small to have an impact, try
going to bed with a
mosquito in your tent"
Public Health and Social Justice
Website
http://www.publichealthandsocialjustice.org
http://www.phsj.org
[email protected]